Endocrine Abstracts

Introduction: Perhaps due to a current global epidemic of “overdiagnosis”, papillary thyroid microcarcinoma (PTM) is now the commonest endocrine malignancy (BMJ 348: 3045, 2014). Current management options vary from lobectomy or total thyroidectomy to “active surveillance”. An alternative approach, used successfully for eliminating neck nodal metastases (JCEM 96: 2717, 2011), is ultrasound-guided percutaneous ethanol ablation (UPEA). Here we present our experience of treating with UPEA biopsy-proven tumour foci in ten PTM patients.

Subjects/methods: Study patients (7F, 3M) were aged, at time of UPEA, 36–86 years (median 52 years); three had significant co-morbidities. The twelve tumours varied from 4 to 10 mm diameter; tumour volumes ranged from 25 to 375 mm³ (median 125). UPEA technique (local anesthetic, outpatient) and follow-up protocol was previously described (Surgery 154: 1448, 2013). The first patient had under ultrasound guidance only a single injection of 0.2 cc 95% ethanol directly into his tumour focus (8mm diameter; 232 mm3volume). Subsequent patients had two injections on consecutive days; ethanol volume injected ranged from 0.45 to 1.25 cc (median 0.9 cc). Three (33%), who had <50% tumour shrinkage, had a 3rd injection at 3–5 months. All patients were followed with neck ultrasound scans, with recalculation of tumour volume and assessment of tumour-associated Doppler flow at each visit.

Results: Patients were followed for 0.3–4.4 years (median 2.0). No patient developed after UPEA a painful thyroiditis; none had hoarseness or hypocalcaemia. All tumour foci have shrunk and Doppler flow eliminated. Average tumour volume reduction was 80% (range 52–100%); 4/12 tumours were no longer identifiable after 0.7–2.2 years (mean 1.5 years).

Conclusions: UPEA for PTM was well tolerated and was substantially (>38 000 USdollars) cheaper than conventional surgery. Our results would suggest that, for PTM patients who do not wish neck surgery and are uncomfortable with “active surveillance”, UPEA likely represents an attractive and “minimally invasive” definitive management option.